Incidence of lower limb amputation in people with and without diabetes: a nationwide 5-year cohort study in Japan

IntroductionThis study was conducted to investigate the incidence and time trend of lower limb amputation (LLA) among people with and without diabetes.Research design and methodsThis retrospective population-based cohort study was based on the national claims data in Japan, comprising a total population of 150 million. Data of all individuals who had LLA from April 2013 to March 2018 were obtained. We analysed the sex-adjusted and age-adjusted annual LLA rate (every fiscal year) in people with and without diabetes for major and minor amputation. To test for time trend, Poisson regression models were fitted.ResultsIn the 5-year period, 30 187 major and 29 299 minor LLAs were performed in Japan. The sex-adjusted and age-adjusted incidence of major and minor LLAs was 9.5 (people with diabetes, 21.8 vs people without diabetes, 2.3, per 100 000 person-years) and 14.9 (people with diabetes, 28.4 vs people without diabetes, 1.9, per 100 000 person-years) times higher, respectively, in people with diabetes compared with those without. A significant decline in the annual major amputation rate was observed (p<0.05) and the annual minor amputation rate remained stable (p=0.63) when sex, age and people with and without diabetes were included as dependent variables.ConclusionsThis is the first report of the national statistics of LLAs in Japan. The incidence of major and minor LLAs was 10 and 15 times higher, respectively, in people with diabetes compared with those without. A significant decline in the major amputation rate was observed, and the annual minor amputation rate remained stable during the observation period. This information can help to create an effective national healthcare strategy for preventing limb amputations, which affect the quality of life of patients with diabetes and add to the national healthcare expenditure.

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What happens to our amputees? The Darling Downs experience

Journal of Orthopaedic Surgery ◽

10.1177/2309499020958477 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902095847

Author(s):

Varun Vasudeva ◽

Adam Parr ◽

Alan Loch ◽

Chris Wall

Keyword(s):

Lower Limb ◽

Treatment Options ◽

Major Amputation ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Mortality Data ◽

Minor Amputation ◽

Poor Outcomes ◽

American Society ◽

End Stage

Background: Major lower limb amputation is occasionally required in the management of end-stage pathology where other treatment options have failed. The primary aim of this study was to determine the 30-day and 1-year mortality rates of patients undergoing nontraumatic major lower limb amputation. Secondary aims were to investigate risk factors for poor outcomes, incidence of previous minor amputation, and the rate of subsequent major amputation. Methods: All nontraumatic, major lower limb amputations performed at Toowoomba Hospital during an 18-year period were retrospectively reviewed. Mortality data were obtained from the Queensland Registry of Births, Deaths and Marriages. Kaplan–Meier analysis was performed to determine survival after amputation. Results: A total of 147 patients were included in the study, with 104 undergoing below knee and 43 undergoing above knee amputations. Ten patients identified as having an Aboriginal and Torres Strait Islander background. For all patients, the 30-day mortality was 4.1% and 1-year mortality was 21.1%. For Indigenous patients, 30-day mortality was 10%. Previous minor amputation had occurred in 40 patients. Twenty-nine patients underwent further minor surgery after their initial major amputation, with thirteen requiring subsequent major amputation. Factors that increased mortality risk were the presence of peripheral vascular disease, an American Society of Anesthesiologists score of four and age greater than 65 years. Conclusion: The morbidity and mortality following major lower limb amputation is significant. The findings of this study highlight the importance of preventative measures to minimize the incidence of lower limb amputations in the future.

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Factors that affect the one-year mortality rate after lower limb amputation in the Hong Kong Chinese population

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/22104917211056949 ◽

2021 ◽

Vol 28 ◽

pp. 221049172110569

Author(s):

Pui M Chung ◽

Bolton KH Chau ◽

Esther C-S Chow ◽

Kwok H Lam ◽

Nang MR Wong

Keyword(s):

Mortality Rate ◽

Lower Limb ◽

Chinese Population ◽

Major Amputation ◽

Lower Limb Amputation ◽

Hong Kong Chinese ◽

Limb Amputation ◽

The Mean ◽

One Year ◽

The One

Introduction Lower limb amputation has significant morbidity and mortality. This study reviews the potential factors affecting the one-year mortality rate after lower limb amputation in the Hong Kong Chinese population. Methods Cases with lower limb amputations (toe, ray, below-knee, and above-knee amputations) from a regional hospital from January 2016 to December 2017 were recruited. Amputations due to trauma were excluded. The one-year mortality rate and the potential risk factors (age, sex, length-of-stay, multiple operations, extent of surgery (minor vs. major), medical comorbidities including (1) end-stage renal failure (ESRF), (2) cardiac diseases, (3) ischemic heart disease, (4) peripheral vascular disease and (5) diabetes mellitus) were analyzed by multiple logistic regression using Matlab 2018a. Results A total of 132 patients were recruited (173 operations). The one-year mortality rate was 36.3%. The mean age at death was 72.2 years. The results of the regression analysis showed patients having ESRF (β = 2.195, t 120 = 3.008, p = 0.003) or a major amputation (including above- or below-knee amputation) (β = 1.079, t 120 = 2.120, p = 0.034), had a significantly higher one-year mortality. The remaining factors showed no significant effect. The one-year mortality rate in ESRF patients was 77.8%; while the one-year mortality rate without ESRF was 29.8%. The mean age at death in the ESRF group was 62.9 years; while that without ESRF was 76.1 years. The one-year mortality for patients with major amputation was 45.8% while that for minor amputation was 20.4%. Conclusion ESRF and major amputation are factors that increase the one-year mortality rate after lower limb amputation.

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Duplex Ultrasound May Predict the Best Level of Lower Limb Amputation in Patients with Chronic Limb-Threatening Ischemia: A Retrospective Observational Cohort Study

Annals of Vascular Surgery ◽

10.1016/j.avsg.2020.02.034 ◽

2020 ◽

Vol 67 ◽

pp. 403-410

Author(s):

Emmy R.I. Janssen ◽

Lysanne van Silfhout

Keyword(s):

Cohort Study ◽

Lower Limb ◽

Duplex Ultrasound ◽

Observational Cohort Study ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Observational Cohort ◽

Retrospective Observational Cohort Study

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Associations between attainment of incentivized primary care indicators and incident lower limb amputation among those with type 2 diabetes: a population-based historical cohort study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-002069 ◽

2021 ◽

Vol 9 (1) ◽

pp. e002069

Author(s):

Laura H Gunn ◽

Eszter P Vamos ◽

Azeem Majeed ◽

Pasha Normahani ◽

Usman Jaffer ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Primary Care ◽

Cohort Study ◽

Lower Limb ◽

Population Based ◽

Lower Limb Amputation ◽

Medical Decision ◽

Limb Amputation

IntroductionEngland has invested considerably in diabetes care through such programs as the Quality and Outcomes Framework (QOF) and National Diabetes Audit (NDA). Associations between program indicators and clinical endpoints, such as amputation, remain unclear. We examined associations between primary care indicators and incident lower limb amputation.Research design and methodsThis population-based retrospective cohort study, spanning 2010–2017, was comprised of adults in England with type 2 diabetes and no history of lower limb amputation. Exposures at baseline (2010–2011) were attainment of QOF glycated hemoglobin (HbA1c), blood pressure and total cholesterol indicators, and number of NDA processes completed. Propensity score matching was performed and multivariable Cox proportional hazards models, adjusting for disease-related, comorbidity, lifestyle, and sociodemographic factors, were fitted using matched samples for each exposure.Results83 688 individuals from 330 English primary care practices were included. Mean follow-up was 3.9 (SD 2.0) years, and 521 (0.6%) minor or major amputations were observed (1.62 per 1000 person-years). HbA1c and cholesterol indicator attainment were associated with considerably lower risks of minor or major amputation (adjusted HRs; 95% CIs) 0.61 (0.49 to 0.74; p<0.0001) and 0.67 (0.53 to 0.86; p=0.0017), respectively). No evidence of association between blood pressure indicator attainment and amputation was observed (adjusted HR 0.88 (0.73 to 1.06; p=0.1891)). Substantially lower amputation rates were observed among those completing a greater number of NDA care processes (adjusted HRs 0.45 (0.24 to 0.83; p=0.0106), 0.67 (0.47 to 0.97; p=0.0319), and 0.38 (0.20 to 0.70; p=0.0022) for comparisons of 4–6 vs 0–3, 7–9 vs 0–3, and 7–9 vs 4–6 processes, respectively). Results for major-only amputations were similar for HbA1c and blood pressure, though cholesterol indicator attainment was non-significant.ConclusionsComprehensive primary care-based secondary prevention may offer considerable protection against diabetes-related amputation. This has important implications for diabetes management and medical decision-making for patients, as well as type 2 diabetes quality improvement programs.

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A survey of lower limb amputation rate in patients with diabetes at Shahid Modarres Hospital, Tehran, Iran, during 5 years

Journal of Analytical Research in Clinical Medicine ◽

10.15171/jarcm.2017.015 ◽

2017 ◽

Vol 5 (3) ◽

pp. 76-81

Author(s):

Nasser Malekpour Alamdari ◽

Barmak Gholizade ◽

Parvin Pashaii

Keyword(s):

Lower Limb ◽

Lower Limb Amputation ◽

Amputation Rate ◽

Limb Amputation ◽

Patients With Diabetes

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Lower limb amputation following venous cannulation for VA-ECMO: a case report

Perfusion ◽

10.1177/02676591211050608 ◽

2021 ◽

pp. 026765912110506

Author(s):

Natasha Habr ◽

Jamal J Hoballah ◽

Jamil Borgi ◽

Caroline Hamadi ◽

Pierre Sfeir ◽

...

Keyword(s):

Lower Limb ◽

Limb Ischemia ◽

Major Amputation ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Venous Cannulation ◽

Knee Amputation ◽

Venous Cannula ◽

Arterial Insufficiency ◽

Va Ecmo

Lower limb amputation following arterial cannulation for VA-ECMO has been described in the literature. Limb ischemia however following venous cannulation is very rare and not quite understood. We present a case of limb ischemia following venous cannulation. A combination of venous congestion, compartment syndrome and subsequent arterial insufficiency is the proposed pathophysiology. Shock and use of vasopressors are compounding factors. Limb ischemia can be transient and reversible if diagnosed immediately and treated by early removal of the cannula. Our patient was unstable and ECMO dependent, and removal of the cannula was not an option. This resulted in limb loss and eventual above knee amputation. Use of the smallest appropriate venous cannula and early fasciotomy, in addition to hemodynamic optimization are measures that could help in preventing major amputation.

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Skin problems of the stump and hand function in lower limb amputees: A historic cohort study

Prosthetics and Orthotics International ◽

10.1080/03093640802016456 ◽

2008 ◽

Vol 32 (2) ◽

pp. 179-185 ◽

Cited By ~ 19

Author(s):

E. C. T. Baars ◽

P. U. Dijkstra ◽

J. H. B. Geertzen

Keyword(s):

Cohort Study ◽

Lower Limb ◽

Hand Function ◽

Study Data ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Amputation Stump ◽

Increased Risk ◽

Co Morbidity ◽

Historic Cohort

The aim of this study was to investigate the relationship between liner-related skin problems of the stump in patients with a lower limb amputation and impaired hand function. Sixty patients who were treated in a rehabilitation hospital from 1998–2006 were included in an historic cohort study. Data were collected concerning the amputation, skin problems of the stump, co-morbidity, hand function, the prosthesis, liner use and mobility score. The study population consisted of 50 trans-tibial and 10 knee disarticulation amputees, 43 male and 17 female, with a mean age of 62.3 years. The majority (63%) had a vascular reason for amputation. Blisters, folliculitis, rash and surface wounds on the stump were operationalized as being liner related. In patients with an impaired hand function, 70% had experienced liner-related skin problems of the stump, whereas 32% of the patients with a normal hand function had experienced skin problems ( p = 0.035). This study shows that impaired hand function poses an increased risk for skin problems in the amputation stump in patients with a lower limb amputation and liner use in their prosthesis.

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